OBJECTIVE To evaluate the predictive power of the risk stratification system proposed in the 2003 European Society of Hypertension-European Society of Cardiology (2003 ESH-ESC) guidelines and to compare self-measured blood pressure at home (HBP) with casual-screening blood pressure (CBP) for prediction of first stroke among a general Japanese population. RESULTS HBP and CBP were measured in 1702 subjects (> or = 40 years) who had no history of stroke and who were followed for an average of 11 years. The subjects were assigned to one of five groups with differential risk stratification according to the 2003 ESH-ESC criteria: average risk, low added risk, moderate added risk, high added risk, and very high added risk. Even in the low risk group a significantly high risk for stroke was observed, and there was a linear step up of stroke risk based on HBP, as well as on CBP. On the basis of HBP classification, a higher stroke incidence was observed in the high and very high groups compared with CBP classification. CONCLUSIONS The risk stratification system proposed in the 2003 ESH-ESC guidelines is valid for the prediction of stroke in this Japanese study population, and has a stronger predictive power when based on HBP than on CBP. The results indicate the usefulness of HBP for the prediction of stroke risk in individuals.